青年脑梗死患者病情严重程度与其危险因素及病因的关系  

The correlations between the etiology or risk factors of cerebral infarction in young patients and the severity

作　　者：付联群[1] 王晓丽[1] 闵连秋[1] 李芳[1] 

机构地区：[1]辽宁医学院附属第一医院神经内科,辽宁锦州121001

出　　处：《广东医学》2015年第1期116-120,共5页Guangdong Medical Journal

基　　金：2012年辽宁省第一批次科学技术计划项目(编号:2012225019)

摘　　要：目的调查青年脑梗死患者发病与复发的危险因素及病因,评估青年脑梗死患者病情严重程度与发病危险因素及病因的关系。方法回顾性分析2006—2013年来自中国北方三级医院的脑梗死数据。18-45岁的脑梗死患者共1 395例被纳入研究,临床评估包括完整的神经系统检查及NIHSS评分,诊断依据病史、生化、影像学及心脏检查,病因诊断按TOAST进行分类。同一患者因脑梗死住院2次及以上视为复发。应用Spearman等级相关分析评价NIHSS与发病危险因素高血压、糖尿病及TOAST亚型的相关性,应用logistic回归分析评价青年脑梗死复发的危险因素。结果 （1）18-45岁的脑梗死患者共1 395例,年龄（38.50±6.318）岁,其中男1 104例（79.1%）。（2）发病危险因素中,发病率较高的有高血压（44.4%）、家族史（39.2%）、脂代谢异常（16.8%）、糖尿病（13.8%）、吸烟（47.1%）、饮酒（41.6%）,以上因素更多见于男性,心瓣膜病、心房颤动及头痛史更多见于女性。（3）TOAST分类：大动脉粥样硬化型596例（42.7%）,心源性90例（6.5%）,小血管病变225例（16.1%）,其他明确病因71例（5.1%）,多个潜在病因168例（12.1%）,病因未明204例（14.6%）,资料缺失41例（2.9%）;（4）NIHSS严重程度：轻度1 066例（76.4%）,中度293例（21.0%）,重度22例（1.6%）,资料缺失14例（1.0%）;（5）NIHSS与糖尿病（P=0.208）、高血压（P=0.869）的相关性不显著,NIHSS与TOAST分类的相关性不显著（P=0.955）;（6）心房颤动是青年脑梗死患者复发的危险因素（OR=3.842,95%CI 1.039-14.203,P=0.044）。结论青年脑梗死发病男性多见,发病危险因素以传统血管危险因素为主,大、小血管病变、多个病因共存及心源性卒中是其常见病因;入院时病情严重程度以轻度为主,入院时病情严重程度与发病危险因素高血压及糖尿病不相关,与病因亚型TOAST分类不相关;预防青年脑梗�Objective To investigate the risk factors and etiology of ischemic stroke in young adults,and to determine the correlation between the baseline NIHSS score and the risk factors or etiologies. Methods This retrospective study reviewed the hospital records of all adults aged between 18 and 45 years with ischemic strokes admitted to tertiary hospital in North China from 2006 to 2013（ n = 1 395）. Clinical evaluation consisted of a complete neurologic examination and the NIHSS score. Diagnostic workup consisted of medical history,extensive laboratory,radiologic,and cardiologic examinations. Stroke etiologies were classified according to the Trial of Org 10 172 in Acute Stroke Treatment（ TOAST）.Those with more than two hospitalized courses for acute cerebral infarction were considered as recurrent inpatients.Spearman rank correlation analysis was used to evaluate potential associations between the baseline NIHSS score and risk factors as well as etiologies. Logistic regression analysis was used to identify predictors of stroke recurrence. Results A total of 1 395 consecutive inpatients aged 18 to 45 years with ischemic stroke. The mean age was（ 38. 50 ± 6. 318） years,with 79. 1% were male. There were high incidences of hypertension（ 44. 4%）,familial history of stroke,hypertension or diabetes（ 39. 2%）,dyslipidemia（ 16. 8%）,diabetes mellitus（ 13. 8%）,smoking（ 47. 1%） and alcohol（ 41. 6%）,which were more prevalent in males. Valvular heart disease,atrial fibrillation and migraine were more observed in females. According to TOAST classification,42. 7% of patients with large artery atherothrombosis stroke,cardioembolic stroke,small artery occlusion strike and other etiologies were accounted for 42. 7%,6. 5%,16. 1%,5. 1%,12. 1% and14. 6% of cases,respectively. According to NIHSS scores,the percentage of severity of diseases for mild,moderate and severe levels were 76. 4%,21. 0% and 1. 6%,respectively. 1. 0% of patients with missing data.（ 5） There was no significant correlation between

关 键 词：青年脑梗死 危险因素 病因 病情严重程度 复发 

分 类 号：R-033[医药卫生]